Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes

Schauer, Philip R.; Kashyap, Sangeeta R.; Wolski, Kathy; Brethauer, Stacy A.; Kirwan, John P.; Pothier, Claire E.; Thomas, Shirley; Abood, Beth; Nissen, Steven E.; Bhatt, Deepak L.

doi:10.1056/nejmoa1200225

Cited by 2,000 publications

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“…The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) study examined 150 T2D patients who either received intensive medical therapy alone or medical therapy in addition to a Roux-en-Y gastric bypass or sleeve gastrectomy. 18 Both surgical groups were significantly more likely to reach target HbA1c levels of 6.0% or less and reduce or eliminate diabetic medications, with lowered fasting plasma glucose and improved insulin sensitivity compared with the intensive medical therapy group. Unsurprisingly, weight loss was also greater in the surgical groups.…”

Section: Discussionmentioning

confidence: 86%

Therapeutic fasting as a potential effective treatment for type 2 diabetes: A 4-month case study

Ku¹,

Ramos²,

Fung³

2017

JMH

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Lifestyle therapy is an integral part of type 2 diabetes (T2D) management, but there remains no consensus on an optimal diet. The objective of this study is to evaluate the efficacy of therapeutic fasting as a treatment for T2D. This case follows a male T2D patient treated at the Intensive Dietary Management Clinic in Scarborough, Ontario, over a 4-month period. The patient’s initial fasting regimen consisted of a 24-h fast, three times a week. Over the course of treatment, the patient gradually extended his fasting period, eventually fasting for 42 h, two to three times a week. By the end of treatment, the patient’s weight was reduced by 17.8% and his waist circumference was reduced by 11.0%. In addition, the patient’s glycated haemoglobin levels decreased from 7.7% to 7.2%, and he was able to completely discontinue his insulin treatment, despite over a decade of insulin usage. The patient did not find it difficult to adhere to the fasting schedule and did not experience any hypoglycaemic episodes or other significant adverse effects. These observations suggest that therapeutic fasting may be a viable treatment option for T2D patients.

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Section: Discussionmentioning

confidence: 86%

Therapeutic fasting as a potential effective treatment for type 2 diabetes: A 4-month case study

Ku¹,

Ramos²,

Fung³

2017

JMH

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“…HbA1c was 7.5% in the medical group 6.4% in the gastric bypass group and 6.6% in the sleeve gastrectomy group. No deaths or life threatening complications occurred [26] . An editorial in the same edition by Zimmet et al [27] suggests that the bariatric surgery should not be seen as a last resort.…”

Section: Sodium Glucose Co-transport-2 Inhibitorsmentioning

confidence: 93%

“…In the same edition of the journal Schauer et al [26] evaluated the efficacy of intensive medical therapy as compared to medical therapy plus Roux en Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The primary end point was the proportion of patients with a glycated haemoglobin level of 6.0% or less, 12 mo after treatment.…”

Section: Sodium Glucose Co-transport-2 Inhibitorsmentioning

confidence: 99%

“…An editorial in the Lancet where the results were published is entitled "SGLT2 inhibitors for diabetes: turning symptoms into therapy" and makes the point that the place of this class of drugs in the treatment of type diabetes is still to be decided [36] . There has been concern about breast and bladder cancer as wellIn the same edition of the journal Schauer et al [26] evaluated the efficacy of intensive medical therapy as compared to medical therapy plus Roux en Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The primary end point was the proportion of patients with a glycated haemoglobin level of 6.0% or less, 12 mo after treatment.…”

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Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors

Tomkin¹

2014

WJD

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Core tip: Treatment of diabetes is difficult. Initial success in achieving treatment goals is followed by deterioration and the necessity for additional treatments. Exciting new drugs with new modes of action, have stimulated diabetologists to strive for improved control in the knowledge that complications will be reduced or prevented. Obese patients, who loose weight on glucagon-like peptide-1 agonists are usually delighted with these drugs but for those who fail to loose weight changing to oral dipeptidyl peptidase-4 inhibitors would seem a good choice. sodium-glucose transporter-2 inhibitors have the added benefit of being effective even if blood sugar is near to target but uro-genital infection is a concern.Tomkin GH. Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors. World J Diabetes 2014; 5(5): 636-650 Available from: URL: http://www.wjgnet.com/1948-9358/full/ v5/i5/636.htm DOI: http://dx.doi.org/10. 4239/wjd.v5.i5.636 INTRODUCTIONReaders interested in diabetes must be sick and tired reading that diabetes is a global problem of immense size and getting worse by the day with predictions that we will all have the disease one day! I exaggerate of course but it is sad to realise that although we know so much more about the condition we have made little progress in reducing or conquering the disease. A recent history of diabetes in the past 200 years by Polonsky [1] gives an excellent review of the history of discovery of so many mechanisms that are faulty in diabetes and the number of Nobel prize winners who have contributed to such wonderful success, yet more and more people are being diagnosed with the condition/disease and the consequences are immense in terms of suffering and financial cost. One should not forget that before the discovery of insulin 90 years ago AbstractIn recent years the treatment focus for type 2 diabetes has shifted to prevention by lifestyle change and to more aggressive reduction of blood sugars during the early stage of treatment. Weight reduction is an important goal for many people with type 2 diabetes. Bariatric surgery is no longer considered a last resort treatment. Glucagon-like peptide-1 agonists given by injection are emerging as a useful treatment since they not only lower blood sugar but are associated with a modest weight reduction. The role of the oral dipeptidyl peptidase 4 inhibitors is emerging as second line treatment ahead of sulphonylureas due to a possible beneficial effect on the beta cell and weight neutrality. Drugs which inhibit glucose re-absorption in the kidney, sodium/glucose co-transport 2 inhibitors, may have a role in the treatment of diabetes. Insulin treatment still remains the cornerstone of treatment in many patients with type 2 diabetes.© 2014 Baishideng Publishing Group Inc. All rights reserved. 636October 15, 2014|Volume 5|Issue 5| WJD|www.wjgnet.com diabetes was a rapidly fatal disease and there was little interest in what we now term type 2 diabetes. Type 2 diabetes now makes up 90% of all diabetes. Insulin resist...

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“…Obesity is defined as a chronic disease (AMA, 2013; WHO, 2010) and a lifelong struggle with a negative impact on health and quality of life (Aguilera, 2014; Schauer et al, 2012). So far, surgical treatment has been shown to be the only long-term solution for weight loss and reducing the number of comorbid conditions (Ayman et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Stabilizing family life after gastric bypass surgery

Bylund

Benzein

Sandgren

2017

International Journal of Qualitative Studies on Health and Well

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Weight-loss surgery requires lifelong lifestyle modifications for the maintenance of weight loss and health effects, and can affect both the individual and family. Earlier research indicates that the quality of social relationships has positive and negative influences on wellbeing and health. There is little research on family-life after a member has undergone gastric bypass (GBP) against obesity. Thus, this study aimed to develop a classic grounded theory about families with a member treated with GBP against obesity. The study design used classic grounded theory and included data from 16 interviews. Families’ shared a main concern of unexpected changes after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. The social process develops differently which entail families: attaining unity, returning to old patterns, or disconnecting to find stability, depending on the discrepancy in expectations and knowledge. This is affected by the overall life situation, life-stage and relationship quality. The theory highlights unexpected change as a potential challenge for the family, as well as how they resolve this. Hence, the theory can be applied in care strategies for families. Identification of families needing support to stabilize family life after GBP requires further research.

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Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes

Cited by 2,000 publications

References 22 publications

Therapeutic fasting as a potential effective treatment for type 2 diabetes: A 4-month case study

Therapeutic fasting as a potential effective treatment for type 2 diabetes: A 4-month case study

Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors

Stabilizing family life after gastric bypass surgery

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